Meibography health score: a simple grading system for isotretinoin-induced meibography alterations on patients with acne vulgaris

ABSTRACT

Purpose:

To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes.

Methods:

After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability.

Results:

The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest.

Conclusion:

The meibography health score exhibited good interrater reliability, particularly in severe cases.

Keywords:
Isotretinoin; Meibography; Meibomian gland dysfunction; Radiologists; Ophthalmologists